Health

“Another methadone victim,” ob served an aide to New York City Ad diction Services Commissioner Gra ham Finney. The sardonic comment was not about another death from methadone overdose—there have been 100 such in the city this year—but about Mr. Finney himself, who sudden ly resigned last week, in part because of what he sees as an overemphasis on the use of methadone in City and Federal drug programs. They have slighted, he believes, the growing prob lem of polydrug users who are not on heroin—and therefore cannot be helped by methadone.

“Another methadone victim.” The comment underlined the dramatic in crease in deaths from overdose—there were only 13 in all of 1971—and the spread of the methadone black mar ket.

There are now over 22,000 heroin addicts who receive methadone at clinics in the city. The Health Services Administration's programs treat about 8,200 patients at the moment, and the rest are receiving the drug in private clinics. Though the number admitted to city clinics is increasing at the rate of about 250 per week there is still a waiting list of 7,000 names. “We can't keep pace with the demand for new facilities,” says Dr. Robert Newman, who administers the city's 41 metha done clinics.

Why the rush? Many drug experts feel that a lot of addicts simply be come tired of the pressure from the daily hustle for drags, and that metha done maintenance offers them an op portunity to stabilize their lives.

When administered orally in slowly increased dosages until tolerance level is reached, the drug blocks the crav ing for heroin without causing the dysfunction or euphoria—the high— produced by heroin. But it is addictive and can be dangerous: When taken orally or intravenously by a person who has not developed a tolerance for the drug, it can be lethal.

Most addicts buy methadone not to get high, but to stop the agonies of withdrawal when heroin is in short supply, and to reduce their heroin “habit.” Methadone is cheaper than heroin—a 40‐milligram hit costs $5 to $10 and lasts for 24 hours, com pared to the $25 to $30 daily cost of a typical heroin habit.

But it is the drug users who are not on heroin and who are looking for a new euphoric kick—those who take amphetamines and other nonopiates, for instance—who make up the bulk of the fatalities.

Where do the pushers get the drug? The chief source seems to be the clinic patients themselves, who either sell some of their own dosages or illegally sign on at more than one clinic and receive more methadone than they need. The drug is administered five days a week in the clinics, but the patients can take home their weekend dose and some who are trusted can get enough so they only have to appear at the clinic once a week. Thefts from smaller clinics and private physicians who have received samples are net uncommon.

For its part, the Health Services Administration is making a major ef fort to combat the problem. And in stitutions with big private programs, such as Bronx State and Beth Israel Hospitals, manage to regulate them selves as strictly as the city does its own clinics, But the smaller private clinics are another matter. Once they have been licensed by the Federal Food and Drug Administration, the clinics are free to set up their own system of controlling the dispensing of the drug. Moreover, city officials cannot police them.

City clinics administer free metha done, and the big private clinics ask the patient to pay what he can afford. But the smaller clinics are run on a profit basis. With that in mind, Federal officials have offered Medicaid cov erage to methadone clinics, in the hope that, since many more addicts would be able to afford private‐clinic care through Medicaid, clinic adminis trptors would tighten their procedures to gain the extra business.

Several drug companies are cur rently experimenting with color cod ing the methadone tablets—different colors for different clinics—so that any illicitly sold methadone could, if discovered, be traced to its source.

There is another, more radical plan under consideration. It would involve a drug called Nalaxone, currently be ing used as the prescribed antidote for methadone overdose. Researchers are experimenting with the drug as a possible antagonist for heroin. The new plan would include a dose of Nalaxone in the methadone tablet it‐ self. If it works, the antagonist would block euphoria and overdose in a non tolerant person without interfering with the therapeutic value of the drug to the heroin addict.

Critics have maintained that if pa tients were forced to come to the clinics seven days a week to get their doses, illegal diversion could be cut back significantly. But Dr. Newman feels this would be counterproductive. “You destroy the purpose of the pro gram if you complicate these people's lives too much,” he says. “A voluntary program has got to meet some of the needs of the addict if it is going to work at all.”

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